Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Monday, October 22, 2012

Roy talks about an "amazing" conference he went to called Partnership with Patients. This conference was started by Regina Holliday, patient-advocate-extraordinaire. Here are some links for things that caught his attention:

Donate to Patient Pod at Medstartr at http://bit.ly/patientpod where Pat Mastors is trying to raise $4200 by OctNov 20 (oops, we missed that deadline) (the date was extended... please help fund the project. ~Roy).

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comments:

For some reason, I cannot find a link to the podcast and the Itunes route does not allow me to access the latest podcast so I have not listened to it.If I were able to access it, I would fast forward to the bit referenced in the comment above. I cannot give my reaction without listening but will only say that I find it to be a two way street. Patients sometimes do "test" their shrinks.The reasons why should be obvious. Patients often come with a history of being not believed, not supported, demeaned and even treated as though they were the only half of the "dyad" that had issues. I have found that shrinks are also adept at testing patients but they are able to couch it in different terms. Patients do not keep files on their shrinks. Head games work can originate from the doc as well. Testing is a loaded term.Since I have not been able to listen to your discussion, I will just say that patients are not always the only sick one in the room. I would ask why any shrink would not expect to be tested given that patients often land in a shrink's office after so many years of being told they are nuts when quite often they are very sane but dealing with trust issues that are normal and same, all things considered. Some shrinks do not take the time to understand this. The best shrinks know they will be tested and view this as a sign of health, not illness. The worst shrinks view any disagreement with their dx and rx as testing. Please post the link so that readers can make informed comments.

I listened to the bit about testing. Clink seemed to understand off the bat what it could look like and mean. She gave examples of how it can play out in prison populations and from her other comments, she sounds like the person best suited to talk about this issue. I did not write the letter but I feel as though the question was otherwise given short shrift. Not sure if the letter writer would agree. I do not agree that patients who do not pay their bill fail to do so because they don't want to part with their money. I bet the same patients pay their plumber and at the grocery checkout. Testing is about seeing if the doc can be trusted and/or about trying to figure out how far it is possible to go before being rejected and I think that it is important for a shrink to understand what testing might look like.If a testing behavior is benign and feels like it is about building trust, I think the shrink should not mention it but should try to remain consistent and see if that helps. If the testing is on the level of something Clink described, it needs to be addressed.There is a danger of viewing every patient request as testing and there is a danger in failing to recognize that testing is happening. And Roy, yes some patients will want to test their shrink's knowledge and do wonder if the shrink is experienced with their issues. Some shrinks test patients. Not unlike clink's example, it could be about small boundary violations that end up with the doc and patient in a relationship that they should not be in,be that financial, social or sexual. Other shrinks may test to see how late they can be for a session. maybe they want to see what it takes for patient to move on to another shrink.Dinah, you seem to have a caseload of pretty healthy people--very few self harm, no suicides. Do you see mostly the worried well?

Most of my patients are well and not too worried.So, if someone does not "look" or behave in a manner that one would associate with mental illness, if they feel good, have intact relationships, and function well at both work and love, but it takes 1, 2, 3, 4, or even 5 medications to attain and maintain this, and perhaps they've been, tormented, hospitalized, or even had ECT in the past, are they "the worried well?"

Dinah,Gee Dinah, that would be me, but I am not one of your patients. I do work in the field and from my shrink friends, I hear of a clientele that presents far more challenges to the shrink than your patients seem to. So it is not unusual for these folks to have had to deal with multiple emergencies and at least one suicide, lots of self harming including substance abuse, self injury, and suicide attempts.

Thanks for discussing my testing/trust question in the podcast. Fandango's comment did a great job of expanding on my original question and made a number of good points. I agree Clink addressed it best, but I also appreciated Dinah and Roy's input. I was curious about your thoughts on the subject since I've heard about patients with personality disorders or childhood abuse and trauma mistrusting/testing their mental health providers, and then there's also the specter of the old psychoanalytical ideas (resistance, testing, etc.) still floating around that may or may not color the perspectives of some shrinks about a patient's behavior or motives. Dinah talked about late arrivals and non-payment, two classic analytic examples, saying she just takes them at face value and doesn't think of them in terms of resistance, testing, etc. I know I've had a couple of experiences where a therapist—two different therapist, actually—became upset or angry about a late arrival or a missed session which I thought was strange since I'm one of those conscientious types that consistently shows up for appointments, payment in hand. I wondered if they were reading more into the situation then there was, and I do believe the trust issue goes both ways in a therapeutic relationship. I've had several excellent therapists, as well as one that was truly awful, and he was the one I found myself testing because I didn't feel understood or accepted, and it wasn't safe to be who I was with him. Enjoyed listening to the podcast.